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Transcoronary pacing for transient CHB during PTCA: A novel salvage

Akshay A Bafna, Varun Deokate

We describe a case of emergency Transcoronary Pacing (TCP) for the management of transient complete heart block during Percutaneous Transluminal Coronary Angioplasty (PTCA). A 60-year-old woman with a past medical history of angioplasty for Left Anterior Descending (LAD) and Right Coronary Artery (RCA) stenosis presented with chest pain and sweating. Her electrocardiography showed NSTEMI (Non-ST Segment Elevation Myocardial Infarction) with ST depression in V5-V6, I and aVL leads. Coronary angiography revealed 80% stenosis at The Left Circumflex Artery (LCX) and 30% In-Stent Restenosis (ISR) in RCA. During PTCA, as the guiding wire advanced to the Left Circumflex Artery (LCX) and the balloon inflated at 8 atm, Complete Heart Block (CHB) developed with a heart rate of 40 beats per minute. The intravenous rescue therapy with atropine was ineffective. An emergency TCP was successfully performed using a guiding wire as a pacing wire. The ventricle rhythm was reversed after 15-20 minutes of TCP initiation, and PTCA was completed uneventfully. We demonstrate that TCP can be a safe and effective technique for emergency management of heart block during PTCA and may be a suitable alternative to transvenous pacing.